The Development and Validation of an Endoscopic Grading System for Barrett’s Esophagus The Prague C & M Criteria Gastroenterology 2006;131:1392~1399 This article is about The Development and Validation of an Endoscopic Grading System for Barrett’s Esophagus ,,,The Prague C & M Criteria this article was published at gastroenterology 2006 volume 13. Prof. 장린 / R3 김석연

Background & Aims Barrett’s esophagus (BE) Aims a premalignant condition for esophageal adenocarcinoma associated with chronic GERD its diagnosis relying initially on recognition of a columnar-lined distal esophagus Salmon-pink in color Biopsy specimen : intestinal metaplasia Aims develop and validate criteria the endoscopic diagnosis and grading of BE Barrett’s esophagus (BE) is a premalignant condition for esophageal adenocarcinoma and associated with chronic gastroesophageal reflux disease. its diagnosis relying initially on recognition of a columnar-lined distal esophagus. The columnar linined mucosa of the distal esophagus. Biopsy specimen reveal intestinal metaplasia They Aimed to develop and validate explicit, consensus-driven criteria for the endoscopic diagnosis and grading of BE.

Material & Methods

Working Group Structure and Meetings A subgroup of the International Working Group for the Classification of Oesophagitis (IWGCO) Research and clinical interest in BE The first meeting - September 2002 Strategies for development of criteria for grading Voting and discussion A su All the members of the subclub,which is International Working Group for the Classification of Oesophagitis have a Research and clinical interest in BE. The first meeting was convened in September 2002 and Strategies for development of criteria for grading of BE Through Voting and discussion

agreed on criteria and developed materials for formal evaluation using video-endoscopic recordings gathered in 29 patients The Criteria C (circumferential) & M (maximum extent) Endoscopically visualized BE segment The working group agreed on criteria and developed materials for their formal evaluation using video-endoscopic recordings gathered in a standardized manner in 29 patients The criteria included assessment of the circumferential & maximum extent of the Endoscopically visualized BE segment as well as endoscopic landmark

FIG 1 is a assessement score sheet for analysis of endoscopy vidieos.

M C C is a extent of circumferential metaplasia, M is maximal extent of the metaplasia. This figure shows C2M5.

C M Video still of endoscopic barrett`s esophagus showing an area classified as C2M5.

Results

R C The RC of Circumferential extent is 0.91, maximal extent 0.66.

Table 3 shows the number of video clips with C and M assessments in the relationship to the length of the BE segment. Almost half of the C assessments but only 5 of the M assessments were less than 0.5cm 29 29

R C The RC of C value were 0.94 C and M was 0.93, representing an “almost perfect” Also, RC of diaphragmatic hiatus and GEJ were “almost perfect”

Table 5 is a percentage agreement for C and M values. The exact rates of the agreements C and M were 53 percents and 38 percents, respectively. Whereas the values for agreement within 2 cm were 97%and 95%,respectively.

Table 6 is a overall kappa values, based on BE length. One above 1 cm was 0.72, the other below 1 cm was 0.21.

Conclusion The Prague C & M criteria have high validity for the endoscopic assessment of visualized BE lengths